Reissig A.,Friedrich - Schiller University of Jena |
Copetti R.,Latisana General Hospital |
Mathis G.,Medical Practice |
Mempel C.,Helios Clinic |
And 6 more authors.
Chest | Year: 2012
Background: The aim of this prospective, multicenter study was to define the accuracy of lung ultrasound (LUS) in the diagnosis of community-acquired pneumonia (CAP). Methods: Three hundred sixty-two patients with suspected CAP were enrolled in 14 European centers. At baseline, history, clinical examination, laboratory testing, and LUS were performed as well as the reference test, which was a radiograph in two planes or a low-dose CT scan in case of inconclusive or negative radiographic but positive LUS findings. In patients with CAP, follow-up between days 5 and 8 and 13 and 16 was scheduled. Results: CAP was confirmed in 229 patients (63.3%). LUS revealed a sensitivity of 93.4% (95% CI, 89.2%-96.3%), specificity of 97.7% (95% CI, 93.4%-99.6%), and likelihood ratios (LRs) of 40.5 (95% CI, 13.2-123.9) for positive and 0.07 (95% CI, 0.04-0.11) for negative results. A combination of auscultation and LUS increased the positive LR to 42.9 (95% CI, 10.8-170.0) and decreased the negative LR to 0.04 (95% CI, 0.02-0.09). We found 97.6% (205 of 211) of patients with CAP showed breath-dependent motion of infiltrates, 86.7% (183 of 211) an air bronchogram, 76.5% (156 of 204) blurred margins, and 54.4% (105 of 193) a basal pleural effusion. During follow-up, median C-reactive protein levels decreased from 137 mg/dL to 6.3 mg/dL at days 13 to 16 as did signs of CAP; median area of lesions decreased from 15.3 cm2 to 0.2 cm2 and pleural effusion from 50 mL to 0 mL. Conclusions: LUS is a noninvasive, usually available tool used for high-accuracy diagnosis of CAP. This is especially important if radiography is not available or applicable. About 8% of pneumonic lesions are not detectable by LUS; therefore, an inconspicuous LUS does not exclude pneu monia. Trial registry: ClinicalTrials.gov; No.: NCT00808457; URL: www.clinicaltrials.gov. © 2012 American College of Chest Physicians.
Cocco G.,From the Medical Practice |
Pandolfi S.,Medical Practice
Journal of Clinical Hypertension | Year: 2011
In spite of appropriate pharmacologic therapy, many hypertensive patients develop an abnormal left ventricular relaxation with preserved systolic function. This cardiac dysfunction increases the risk of cardiovascular complications. The authors assessed the therapeutic effects of an intervention with exercise training and weight reduction in patients with pharmacologically well-treated hypertension who had abnormal left ventricular relaxation with normal systolic function. Eighty-eight (44%) of 202 medically treated hypertensive patients had abnormal ventricular relaxation with normal ejection fraction. These patients were randomized to either a 6-month intervention program (cycle ergometer training twice a day for 5 days a week and a hypocaloric diet) or a control program (unchanged pharmacologic therapy without exercise and diet. Body weight, blood pressure, New York Heart Association class, glomerular filtration rate, and exercise capacity and workload were measured. Cardiac function was assessed by measuring N-terminal pro-B-type natriuretic peptide values, the electrocardiographic QT dispersion interval, and echocardiography (left atrial size, Doppler-derived E/A ratio, and mitral deceleration time). Physical exercise with weight reduction reduced blood pressure, decreased cardiovascular risks, and improved abnormal left ventricular relaxation. Measuring left atrial size is the best method for assessing changes in left ventricular relaxation with preserved systolic function. © 2010 Wiley Periodicals, Inc.
Schleenvoigt B.T.,Jena University Hospital |
Baier M.,Jena University Hospital |
Hagel S.,Jena University Hospital |
Forstner C.,Jena University Hospital |
And 3 more authors.
Infection | Year: 2015
Ross River virus (RRV) is an arbovirus transmitted by Aedes and Culex mosquitos. It is endemic in Australia, New Zealand and south-east Asia. Clinical manifestation rates in adults range about 20–40 %. Symptoms involve arthralgia, myalgia, lymphadenopathy, fever and rash. Here we report a case of RRV in a Thuringian traveller who visited the urban South-East of Australia. © 2014, Springer-Verlag Berlin Heidelberg.
Berger B.,University Hospital Freiburg |
Baumgartner A.,University Hospital Freiburg |
Rauer S.,University Hospital Freiburg |
Mader I.,University Hospital Freiburg |
And 3 more authors.
Journal of Neuroimmunology | Year: 2015
Objectives: Fingolimod is a well-established, highly effective immunomodulatory treatment for patients with relapsing-remitting multiple sclerosis (RRMS). However, little is known about disease course after its discontinuation. Methods: This is a case series on four patients with RRMS who had a severe reactivation after fingolimod discontinuation. Results: One patient had pretreatment with glatiramer acetate, interferon-β 1b and interferon-β 1a and another with interferon-β 1a, intravenous immunoglobulins and natalizumab whereas the other two were therapy naïve before fingolimod initiation. Patients were treated with fingolimod for two, thirty, forty-five and seventy-eight months, respectively. Fingolimod had to be discontinued because of persisting lymphopenia, severe varicella zoster virus infection, subarachnoid hemorrhage, and increased liver function enzymes, respectively. Between two to four months after fingolimod cessation these patients had a severe relapse. Cerebral magnetic resonance imaging (MRI) at this point revealed multiple new lesions, partially with contrast ring enhancement. Partial recovery was achieved after steroid pulse therapy followed by plasma exchange in two patients. Conclusions: Despite the limited evidence from our case series on potential disease reactivation exceeding pre-fingolimod activity in a subgroup of RRMS patients, particularly patients with previously high disease activity should undergo frequent clinical as well as radiological monitoring after fingolimod discontinuation. © 2015 Elsevier B.V.
Ullrich D.,Medical Practice |
Ullrich K.,Flinders University |
Marten M.,Kindergarten with Focus on Speech language Development
International Journal of Language and Communication Disorders | Year: 2014
Background In Lower Saxony, Germany, pre-school children with language-and speech-deficits have the opportunity to access kindergartens with integrated language-/speech therapy prior to attending primary school, both regular or with integrated speech therapy. It is unknown whether these early childhood education treatments are helpful and effective.Aims To determine the value of early language-/speech therapy treatment in combination with support of personality traits during the pre-school and primary school period on the long-term social and academic development of children with significant language-/speech delay.Methods & Procedures We conducted prospective longitudinal case series, following the academic progress of 71 children after they had been discharged from a speech therapy kindergarten (STK) up to 19 years previously. Data collection included details on language/speech impairment, socio-economic factors, psycho-social skills and intelligence quotient. Results & Implications At the end of the follow-up period, 58 children were attending secondary schools: 44 (76%) children attended a regular secondary school, whereas 14 (24%) children were enrolled in a school with special needs education. The results suggest that self-awareness and intelligence quotient in this study cohort correlated with later academic achievements. Conclusion & Implications Kindergartens and primary schools which support curriculum-integrated language-/speech therapy and allow for different personality traits appear to improve longterm development and academic outcome of children with language-/speech impairment or delay. © 2014 Royal College of Speech and Language Therapists.